Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston MA, USA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston MA, USA.
Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston MA, USA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston MA, USA; Boston IVF, 103 2nd Avenue, Waltham MA, USA.
Reprod Biomed Online. 2020 Dec;41(6):981-989. doi: 10.1016/j.rbmo.2020.07.014. Epub 2020 Jul 22.
Day of cryopreservation, inner cell mass (ICM) grade, trophectoderm grade and blastocyst expansion grade have been associated with differences in live birth rate in frozen embryo transfer (FET) cycles. This study sought to examine the likelihood of live birth and whether the morphological grade of the blastocyst is more or equally useful in FET cycles among preimplantation genetic testing for aneuploidies (PGT-A) tested and untested blastocysts.
This was a retrospective cohort study of 6271 vitrified-warmed, autologous, single-embryo transfer cycles among patients undergoing IVF from July 2013 to December 2017 at a single, university-affiliated infertility practice. The primary outcome was live birth, calculated by generalized estimating equations.
Among PGT-A tested embryos, inferior ICM grade was associated with a lower chance of live birth (ICM grade B versus A: adjusted risk ratio [aRR] 0.91, 95% confidence interval [CI] 0.84-0.99). Among untested blastocysts there was a lower live birth rate in blastocysts cryopreserved on day 6 versus day 5 (aRR 0.87, 95% CI 0.78-0.96), and those with inferior pre-vitrification trophectoderm grade (trophectoderm grade B versus A: aRR 0.86, 95% CI 0.79-0.94). Blastocysts with a higher pre-vitrification expansion grade (pre-vitrification expansion grade 5 versus 4: aRR 1.1, 95% CI 1.01-1.2) were associated, but ICM grade was not associated (ICM grade B versus A: aRR 0.93, 95% CI 0.86-1.02), with chance of live birth.
Among PGT-A untested blastocysts, assessing embryo quality by day of cryopreservation, trophectoderm grade and expansion grade may help to identify embryos with the highest likelihood of live birth. Identifying euploid embryos by PGT-A appears to homogenize the cohort, making blastocyst morphological grade and day of cryopreservation less important.
在冷冻胚胎移植（FET）周期中，冷冻日、内细胞团（ICM）等级、滋养外胚层等级和囊胚扩张等级与活产率的差异有关。本研究旨在检查植入前遗传学检测（PGT-A）检测和未检测的囊胚在 FET 周期中的活产率的可能性，以及囊胚形态学等级是否更有用或同样有用。
这是一项回顾性队列研究，纳入了 2013 年 7 月至 2017 年 12 月期间在一家大学附属不孕不育诊所接受体外受精的 6271 例患者的玻璃化冷冻-解冻的自体单胚胎移植周期。主要结局是通过广义估计方程计算的活产率。
在 PGT-A 检测的胚胎中，较差的 ICM 等级与较低的活产率相关（ICM 等级 B 与 A：调整风险比[aRR]0.91，95%置信区间[CI]0.84-0.99）。在未检测的囊胚中，第 6 天冷冻的囊胚的活产率低于第 5 天（aRR 0.87，95%CI 0.78-0.96），且在玻璃化前滋养外胚层等级较差的囊胚（滋养外胚层等级 B 与 A：aRR 0.86，95%CI 0.79-0.94）。玻璃化前扩张等级较高的囊胚（扩张等级 5 与 4：aRR 1.1，95%CI 1.01-1.2）与活产率相关，但 ICM 等级与活产率无关（ICM 等级 B 与 A：aRR 0.93，95%CI 0.86-1.02）。
在未检测的 PGT-A 囊胚中，通过冷冻日、滋养外胚层等级和扩张等级评估胚胎质量，可能有助于识别具有最高活产率的胚胎。通过 PGT-A 识别出整倍体胚胎似乎使队列同质化，使囊胚形态学等级和冷冻日变得不那么重要。
